Review Question - QID 216497

This patient with a history of sexual abuse presents to establish care with a primary care physician. When addressing the abuse, the physician should listen and respond with empathetic statements such as, “I’m sorry you’ve had to deal with this. Is there anything else you are comfortable sharing?”

When addressing a history of sexual abuse, the physician should be an active listener and give the patient adequate room to talk. Empathetic statements should be used to convey that the physician understands the concerns and feelings that have been shared. When used effectively, active listening and empathetic statements build trust in the patient-physician relationship and solidify the treatment alliance between physician and patient. Avoid judgmental statements, over-pathologizing of disease, or prematurely jumping to treatment as these may discourage the patient from sharing additional information. After a full history is obtained, it is appropriate to discuss possible treatment methods with the patient if they are interested in seeking therapy.

Paras et al. studied the effects of sexual abuse on the lifetime diagnosis of somatic disorders. They found that a significant association exists between sexual abuse and fibromyalgia as well as functional gastrointestinal disorders. They recommend having a higher index of suspicion for these disorders in patients with a history of sexual abuse.

Incorrect Answers:
Answer 1: “I will prescribe a course of trauma-focused psychotherapy” is inappropriate because it prematurely jumps to treatment. Trauma-focused psychotherapy is the first-line treatment for post-traumatic stress disorder (PTSD); this patient has not been evaluated for PTSD, which requires the presence of intrusive symptoms and avoidance behavior. The physician should first listen empathetically.

Answer 2: “I will refer you to a psychiatrist for evaluation of post-traumatic stress disorder” is inappropriate because the physician should first listen empathetically to avoid over-pathologizing of disease. Additionally, a psychiatrist is not needed to make a diagnosis of PTSD.

Answer 4: “It sounds like that happened a long time ago. I suggest we work together to help you move on.” is inappropriate because it is dismissive of the patient’s feelings and can be perceived as judgmental or callous.

Answer 5: “Let me give you a pamphlet with resources for sexual abuse survivors” may be appropriate if the patient asks for additional resources. However, the physician should first listen to the patient’s feelings and concerns without assuming that additional resources are wanted or needed.

Bullet Summary:
When providing care for patients with a history of sexual abuse, the first step is empathetic, non-judgmental listening.